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<link href="style.css" rel="stylesheet" type="text/css">
<link href="inside.css" rel="stylesheet" type="text/css">
<title>繳費回報</title>
<script type="text/JavaScript">
function check_form()
{
	if(document.form1.inbank.value=='')
	{
		alert("請輸入匯入郵局或銀行");
	    return (false);
	}    		
     if(document.form1.name.value=="")
    {
        alert("請輸入匯款人");
        return (false);
    }   	
	
	if(document.form1.addr.value=="")
    {
        alert("請輸入地址");
        return (false);
    }
	if(document.form1.price.value=="")
    {
        alert("請輸入匯款金額");
        return (false);
    }  
	if(document.form1.m.value==""||document.form1.d.value==""||document.form1.h.value==""||document.form1.i.value=="")
    {
        alert("請輸入完整的日期");
        return (false);
    }   
	
	if(document.form1.linkman.value=="")
    {
        alert("請輸入匯款聯絡人");
        return (false);
    } 	
	
	if(document.form1.tel.value=="")
    {
        alert("請輸入匯款聯系的電話人");
        return (false);
    } 	
	  
}
</script>
</head>

<body>
<div id="container">
<!--header-->
<{include file="./header.html"}>   
<!--header-->

<!--menu-->
<{include file="./menu.html"}> 
<!--menu-->
<div class="main2">
  <div class="inside-left">
    <div id="left" style="padding:19px;">
      <div style="font-size:14px; font-weight:bold; color:#FF6600;">已繳費回報</div>
      <div style="margin-top:5px; text-align:left;"><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0>
  <TBODY>
  <TR>
    <TD width="100%">

     <form method="post" action="payback.php" name="form1" style="border:0" onSubmit="return check_form()">
      <TABLE cellSpacing=0 cellPadding=0 width="100%" bgColor=#bbbbbb 
        border=0><TBODY>
        <TR>
          <TD>
            <TABLE cellSpacing=0 cellPadding=5 width="100%" border=0>
              <TBODY>
              <TR align=middle>
                <TD height="30" 
                  colSpan=2 background=images/zhuce_78.jpg class=GreenFont>繳費資料輸入</TD>

              </TR>
              <TR bgColor=#ffffff>
                <TD width="24%" height="40" class=GreenFont>匯入郵局或銀行:</TD>
                <TD width="76%" height="30" class=RedFont><INPUT name=inbank class="input4" id=T1 
                  size=40 maxLength=40></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>郵政劃撥電腦編號: <BR>
                  <SPAN 
                  class=RedFont>(銀行匯款,或ATM轉帳免填) </SPAN></TD>
                <TD height="30" class=RedFont><INPUT name=innum class="input4" id=T2 maxLength=26></TD></TR>

              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>匯出銀行: <BR>
                  <SPAN class=RedFont>(郵局劃撥免填) 
                  </SPAN></TD>
                <TD height="30" class=RedFont><INPUT 
              name=outbank class="input4" id=T3 size=40 maxLength=40></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>匯出帳號: <BR>
                  <SPAN 
                  class=RedFont>(郵局劃撥免填)</SPAN> </TD>
                <TD height="30" class=RedFont><INPUT 
              name=outnum class="input4" id=outnum size=40 maxLength=40></TD></TR>

              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>匯款人: </TD>
                <TD height="30" class=RedFont><INPUT name=name class="input4" id=T5></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>匯款時間:</TD>
                <TD height="30"><INPUT name=m class="input4" id=T6 size=4 maxLength=6> 
                月 <INPUT name=d class="input4" id=T7 size=4 
                  maxLength=6> 
                日 <INPUT 
                  name=h class="input4" id=T8 size=4 maxLength=6> 
                時 <INPUT name=i class="input4" id=T9 size=4 maxLength=6> 
                分</TD></TR>

              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>郵寄地址: </TD>
                <TD height="30"><SPAN class=RedFont>
                  <INPUT 
                  name=addr class="input4" id=T10 size=40 maxLength=40> 
                </SPAN></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>匯款金額: </TD>
                <TD height="30" class=RedFont><INPUT 
                name=price class="input4" id=T11 size=12 maxLength=12></TD></TR>
              <TR bgColor=#ffffff>

                <TD height="40" class=GreenFont>聯絡人姓名:</TD>
                <TD height="30" class=RedFont><INPUT name=linkman class="input4" id=T12></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>聯絡電話:</TD>
                <TD height="30" class=RedFont><INPUT name=tel class="input4" id=T13></TD></TR>
              <TR bgColor=#ffffff>
                <TD height="40" class=GreenFont>&nbsp;</TD>
                <TD height="30" 
              class=RedFont><INPUT name=Submit type=submit class="INPUT3" value=確定送出>

              <input type="hidden" name="add" value="1"> </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><SPAN 
      class=BlueFont><A href="javascript:window.history.back();"><BR><IMG 
      height=17 src="images/back.gif" width=69 border=0></A></SPAN> 
      </FORM></TD>
    </TR></TBODY></TABLE>
      </div>
    </div>
  </div>
  <div class="inside-right">
  
   <!--right-->
    <{include file="./right.html"}> 
    <!--right-->
  
  </div>
</div>
<!--foot-->
<{include file="./footer.html"}> 
<!--foot-->
</div>
</body>
</html>
